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Treating postherpetic neuralgiaThere are several types of medication used to treat the symptoms of postherpetic

neuralgia. You may need to try different medications before you find a combination suitable for

you.If you have postherpetic neuralgia, you can try a number of things which may help reduce the painful

symptoms of the condition.

Some measures you can take to reduce pain are described below.• Wear comfortable clothing – clothes that are too tight or made of rough or

synthetic material may irritate your skin and make your symptoms worse. Wearing

cotton clothing will usually cause less irritation.• Cover sensitive areas – you may find some areas of your skin are more

affected by postherpetic neuralgia than others. If your clothes tend to rub in certain

areas, try covering them with a plastic wound dressing or cling film.• Use cold packs – unless your postherpetic neuralgia is made worse by cold,

you could try using gel-filled cold packs to numb the pain. Simply place the pack in

the free er to cool it down before placing it gently against your skin.

!europathic pain does not respond well to ordinary painkillers, such as aspirin, paracetamol and

ibuprofen. " stronger painkiller, such as codeine or tramadol, may be prescribed.

#ther medications can also be used to help ease and manage the pain such as tricyclic medications,

anti-epileptic medication such as gabapentin, and opioid pain medications such as morphine.

Things to consider

There are a number of things to consider when trying different treatments, such as$

• why the medication is being offered

• the benefits of the medication

• potential side effects of the medication, such as drowsiness, poor concentration

and loss of balance

• how the medication could potentially affect day-to-day life

• the preferred medication of the person with neuropathic pain

• whether you are taking any other medications• any physical or mental health problems that you are e%periencing

Initial treatments

Two main treatments are recommended for treating neuropathic pain such as postherpetic neuralgia.

These medications are$• amitriptyline• pregabalin

If you are already taking a medication to manage your neuropathic pain, you should be able to

continue taking this while starting a new form of treatment.

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"mitriptyline and pregabalin may help reduce your pain significantly, but they might not ease it

completely.

Amitriptyline

"mitriptyline is a tricyclic antidepressant shown to be effective at treating neuropathic pain as well as

depression. It works by affecting chemicals in your brain and the spinal cord that react to pain, and

can make them less sensitive.

&oses of amitriptyline start low and build up over a few weeks depending on the benefits and side

effects. It may take up to '-( weeks to feel the full effects as the correct dose is reached.

)ommon side effects of amitriptyline include$

• dry mouth

• sweating

• problems passing urine

• slight blurring of vision

• drowsiness

&ue to the drowsiness caused by amitriptyline, you should not drive until you are on a stable dose

that does not cause drowsiness and poor concentration.

If you are prescribed amitriptyline and your painful symptoms are reduced but you cannot tolerate the

side effects, you may be offered an alternative antidepressant such as$• imipramine• nortriptyline

Pregabalin

*regabalin is an anti-epileptic +anticonvulsant medication used to treat epilepsy . ike amitriptyline, it

is also effective in helping people with neuropathic pain. It works by helping damp down/ nerve

impulses.

0oth amitriptyline and pregabalin can be taken as tablets or in the form of a syrup. 1ou will be started

on a low dose, which will be gradually increased over time. It may be a number of weeks before you

start to feel the benefits.

&i iness and drowsiness are the two most common side effects of pregabalin. Therefore, do not

drive or operate heavy machinery if you have these side effects. #ther side effects of pregabalin may

include$

• lack of co-ordination

• weight gain

• fluid retention

• temporary memory impairment

Alternative treatments

If the medication you are taking is not effective in managing your neuropathic pain, you may be

prescribed alternative treatments and referred to a specialist pain clinic to help manage your pain.

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While you are waiting to be referred to a pain clinic you may be prescribed$

• tramadol

• lidocaine patches

Tramadol belongs to a group of medicines called opioids. It is an effective painkiller that can help to

treat neuropathic pain.

)ommon side effects of tramadol can include$

• nausea +feeling sick

• di iness

• constipation

• sweating

• dry mouth

• confusion• headache

• vomiting

ike all opioids, tramadol can be addictive if taken over long periods of time, so it should be

prescribed for the shortest time possible.

If you cannot take tablets or syrup for medical reasons, your 2* may offer you a treatment called

lidocaine patches.

" lidocaine patch can provide pain relief without many side effects. It can also be used in combination

with other treatments.idocaine plasters contain a local anaesthetic, which has a painkilling effect on the area where the

plaster is applied. 3ake sure you follow the instructions that come with the lidocaine plasters when

applying them to your skin.

#ther types of opioids, such as morphine or o%ycodone, may be offered as a treatment for

neuropathic pain, although in some cases you may need to be assessed in a specialist pain clinic.

1our 2* can continue to prescribe medications that have been recommended by pain specialists.

Complementary therapies

Some people find using complementary therapies alongside regular treatment can help them managepain, stress and an%iety.

)omplementary therapies include$

• meditation and other rela%ation techni4ues

• massage

• acupuncture

• vitamin therapy

5owever, there is currently no clinical evidence for the effectiveness of these treatments.

1ou could also try rela%ing activities, such as listening to soothing music and taking warm baths.

6ead more information and tips for managing stress .

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Assessment

While you are being treated for neuropathic pain, your progress will be regularly reviewed to assess

how effectively you are responding. In each review, the following will be assessed and taken into

consideration$

• how much your neuropathic pain has been reduced

• whether you are having adverse side effects from the medication

&epending on the outcome of your reviews, your medication may be changed or the dosage may be

altered.

Postherpetic neuralgiaPostherpetic neuralgia (post-her-PET-ic noo-RAL-jah) is a complication of shingles, which is caused

by the chickenpox (herpes zoster) virus. Most cases of shingles clear up within a few weeks. But if the

pain lasts long after the shingles rash and blisters have disappeared, it's called postherpetic

neuralgia.

Postherpetic neuralgia affects your nerve fibers and skin, and the burning pain associated with

postherpetic neuralgia can be severe enough to interfere with sleep and appetite. The risk of

postherpetic neuralgia increases with age, primarily affecting people older than 60. The area affected

also makes a difference. When shingles occurs on the face, for example, the likelihood of postherpetic

neuralgia is significantly higher than for other parts of the body.

Currently, there's no cure for postherpetic neuralgia, but there are treatment options to ease

symptoms. For most people, postherpetic neuralgia improves over time

Treatments and drugsThere is no single treatment that relieves postherpetic neuralgia in all people. In many cases, it may

take a combination of treatments to reduce the pain.

Lidocaine skin patches

These are small, bandage-like patches that contain the topical, pain-relieving medication lidocaine.

These patches can be cut to fit only the affected area. You apply the patches, available by

prescription, directly to painful skin to deliver temporary relief.

Capsaicin skin patches

These patches contain a very high concentration of an extract of chili peppers (capsaicin), which can

be effective at relieving the nerve pain of postherpetic neuralgia. Capsaicin is available as a low-

concentration cream over-the-counter and can improve pain over several weeks if the application is

tolerated — it causes a burning sensation in many people. The capsaicin skin patch is a much higher

concentration and is given only in your doctor's office by trained personnel after first applying a

numbing medication to the affected area. The process takes at least two hours, but a single

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application is effective in decreasing pain for soxcreme people for up to three months. If effective, the

application process can be repeated every three months.

Anticonvulsants

Certain anti-seizure medications can lessen the pain associated with postherpetic neuralgia. These

medications stabilize abnormal electrical activity in your nervous system caused by injured nerves.

Doctors may prescribe gabapentin (Neurontin, Gralise), pregabalin (Lyrica) or another anticonvulsant

to help control burning and pain. Side effects of these drugs include drowsiness, unclear thinking,

unsteadiness and swelling in the feet.

Antidepressants

Certain antidepressants — such as nortriptyline (Pamelor), amitriptyline, duloxetine (Cymbalta) and

venlafaxine (Effexor XR) — affect key brain chemicals that play a role in both depression and how

your body interprets pain. Doctors often prescribe antidepressants for postherpetic neuralgia in

smaller doses than they do for depression alone. Common side effects of these medications include

drowsiness, dry mouth, lightheadedness and weight gain. Side effects may vary depending on the

antidepressant.

Opioid painkillers

Some people may need prescription-strength pain medications containing tramadol (Ultram, Ryzolt,

Conzip), oxycodone (Percocet, Roxicet, Tylox) or morphine. Opioids can cause mild dizziness,

drowsiness, confusion and constipation. They can also be addictive. Although this You may find that

the following over-the-counter medications ease the pain of postherpetic neuralgia:• Capsaicin. Capsaicin cream, made from the seeds of hot chili peppers, may relieve pain from

postherpetic neuralgia. Capsaicin (Capzasin-P, Zostrix) can cause a burning sensation and irritateyour skin, but these side effects usually disappear over time. Capsaicin cream can be very

irritating if rubbed on unaffected parts of your body. Follow the application instructions carefully,

including wearing gloves for application and washing your hands thoroughly after applying.

• Topical analgesics and anesthetics. Aspirin mixed into an absorbing cream or

nonprescription-strength lidocaine cream may reduce skin hypersensitivity.

risk is generally low, discuss it with your doctor. Tramadol has been linked to psychological reactions,

such as emotional disturbances and suicidal thoughts. These medications should not be combined

with alcohol or other drugs and may impair your ability to drive.

Prevention

The herpes zoster vaccine (Zostavax) has been shown to decrease the risk of shingles by almost 70

percent. The vaccine has been shown to be effective and is approved by the Food and Drug

Administration for adults age 50 and older and is recommended for all adults 60 and older regardless

of whether they have had shingles in the past.